微脉冲低能量激光治疗治疗干性年龄相关性黄斑变性1年随访

正目的:微脉冲低能量激光治疗干性年龄相关性黄斑变性1年随访结果,分析其安全性及临床疗效。方法:回顾性分析经眼底检查、眼底荧光血管造影(FFA)、吲哚青绿血管造影(ICGA)和OCT诊断为干性年龄相关性黄斑变性,伴玻璃膜疣的患者23例26只眼,于黄斑部玻璃膜疣处进行微脉冲低能量激光光凝,光斑直径100μm,能量:150~3 500 mW,微脉冲方式200 ms中含100个微脉冲,一个微脉冲含200μs出光和1 800μs间隔,负载系数     

急性多灶性缺血性脉络膜病变的诊断与治疗

目的：研究急性多灶性缺血性脉络膜病变(AMIC)的视网膜和脉络膜循环特点，探讨该病的发病机制及其治疗。方法：8例AMIC患者的16只眼吲哚青绿血管造影(ICGA)和荧光素钠眼底血管荧光造影(rrA)检查结果进行对比分析，及抗病毒、抗过敏及改善循环等相应的药物治疗。结果：8例16眼FFA检查早期呈不规则的低荧光，晚期呈现圆形或类圆形的荧光蓄积性强荧光。在ICGA造影早期有脉络膜灶状无灌注区，晚期ICGA均有相应的渗漏灶、充盈不良。经3～4周治疗后视力、眼底、FFA及1CGA完全恢复正常。结论：AMIC属脉络膜缺血性疾病，多为病毒感染，经积极治疗很快恢复正常且不留任何痕迹。     

光动力疗法联合不同激光及抗VEGF药物(Bevacizumab)治疗黄斑部CNV的安全性和临床疗效观察

目的:观察光动力疗法(PDT)联合不同激光及抗VEGF药物(Bevacizumab)治疗黄斑部CNV的安全性和临床疗效。方法:经直接或间接眼底镜、彩色眼底照相、荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)和光学相干断层扫描(OCT)检查确诊为黄斑部CNV的患者,其中AMD者102例105只眼,PM者53例53只眼,中渗者25例26只眼,     

PDT联合不同激光及抗VEGF药物治疗黄斑部CNV的9年临床疗效观察

正目的:观察光动力疗法(PDT)联合不同激光及抗VEGF药物(Bevacizumab或Lucentis)治疗黄斑部CNV的9年临床疗效。方法:2007~2009年,经直接或间接眼底镜、彩色眼底照相、荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)和光相干断层扫描(OCT)检查确诊为黄斑部CNV的患者190例194只眼,其中AMD102例105只眼,PM 53例53只眼,中渗25例26组眼,PCV10例10只眼,所有患者均行     

577nm阈下微脉冲激光治疗中心性浆液性脉络膜视网膜病变前后脉络膜厚度的改变

目的:定量分析577 nm阈下微脉冲激光对中心性浆液性脉络膜视网膜病变(CSC)患者治疗前后脉络膜厚度改变,评估治疗疗效。方法:符合入组标准的CSC患者30例30只眼,采用577 nm阈下微脉冲激光治疗。所有患者均接受了最佳矫正视力(BCVA)、光学相干断层扫描(OCT)、荧光素眼底血管造影(FFA)和吲哚氰绿血管造影(ICGA)检查,并于治疗后1个月复查。比较治疗前后患眼最佳矫正视力及黄斑中心凹下脉络膜厚度的改变情况。结果:30例CSC患者治疗BCVA为(0.46±0.13),治疗后1个月(0.79±0.22);治疗前黄斑中心凹下脉络膜厚度为(497±100.31)μm,治疗后黄斑中心凹下脉络膜厚度为(352.89±81.26)μm,两者差异具有统计学意义(P﹤0.05)。结论:577 nm阈下微脉冲激光治疗中心性浆液性脉络膜视网膜病变能提高患眼视力,减轻黄斑中心凹下脉络膜厚度,是一种有效治疗方法。     

激光治疗早期年龄相关性黄斑变性的临床观察

目的探讨氩激光和半导体激光对黄斑玻璃膜疣和视功能的影响.方法对黄斑部有软性玻璃膜疣的60例90只眼患者,随机分为氩激光组、半导体激光组和对照组,激光组分别采用直接光凝和间接光凝2种不同的方法,利用阈值下的激光能量光凝玻璃膜疣;对照组采用常规药物治疗.治疗后根据患者视力、眼底变化、FFA检查结果综合评价疗效.结果随访9～18个月,氩激光组和半导体激光组的有效率分别为46.7%和53.3.%,均无脉络膜新生血管形成.对照组6只眼(20.0%)玻璃膜疣增加.结论利用阈值下的氩激光和半导体激光能量,对早期后极部玻璃膜疣光凝治疗,可促进玻璃膜疣的吸收,减少病变扩大保护视功能.     

光动力疗法治疗高原地区年龄相关性黄斑变性一年疗效观察

目的:研究光动力疗法(PDT)治疗高原地区年龄相关性黄斑变性(AMD)的临床疗效。方法:分析采用PDT治疗高原地区AMD的患者44例47只眼,随访一年的临床疗效。结果:本组47只眼随访一年,术后视力稳定29只眼(61.70%),下降18只眼(38.30%);术后眼底荧光血管造影(FFA)和吲哚菁绿血管造影(ICGA)渗漏无增加32只眼(68.09%),渗漏增加15只眼(31.91%)。治疗后中心视网膜厚度(CRT)明显降低,为(439.05±14.79)μm;病灶最大线性距离(GLD)缩小,为(1.54±0.84)mm。有2例术后发生腰背部酸痛反应,不良反应发生率为4.26%。结论:PDT可以有效治疗高原地区AMD,减轻新生血管的渗漏,保持AMD患者视力稳定,无明显不良反应发生,治疗安全;但治疗后仍有复发需再次治疗。     

微脉冲激光治疗干性AMD

干性AMD是由于色素上皮代谢障碍、消化残余物排出在玻璃膜上集聚所致。1型干性AMD玻璃膜疣在黄斑区不规则分布,最终会导致不规则的色素上皮萎缩;2型干性AMD玻璃膜疣在中心凹集中分布,表现在中心凹处的圆形色素上皮脱离,最终会导致地图状色素上皮萎缩。微脉冲激光采用低能量、短脉冲、阈值下激光可以选择性作用于RPE层,避免激光的热损伤,从而治疗干性AMD的玻璃膜疣及玻璃膜疣性AMD。本研究团队前期的动物试验也证实微脉冲激光可在损伤RPE结构的前提下,调节RPE细胞的功能。通过一系列针对玻璃膜疣及玻璃膜疣性进行微脉冲激光治疗的病例,笔者发现微脉冲激光可以明显改善干性AMD患者的黄斑功能及形态。     

特发性浆液性视网膜色素上皮脱离影像学观察

特发性浆液性色素上皮脱离(idiopathicmultipleserousdetach mentsofretinalPigmentepithelium)国内鲜见报道。作者用荧光眼底血管造影、吲哚青绿脉络膜眼底血管造影、光学相干断层扫描法观察其影像学表现,旨在为临床提供诊断治疗依据。患者男性,5 2岁,右眼视力下降、视物变形4年,曾服用中药治疗无效。全身检查正常。眼部检查矫正视力右眼0 0 8,左眼0 5 ,外眼及眼前节无异常,双眼视盘边界清楚,视网膜血管正常,右眼底黄斑颞上方囊性外观,灰白色局限性隆起,左眼底黄斑部色素紊乱,无水肿,中心凹反射消失。荧光眼底血管造影显示,早期黄斑中心…     

PDT治疗特发性黄斑部浆液性视网膜色素上皮脱离的临床观察

正目的:观察光动力疗法(PDT)治疗黄斑部特发性浆液性视网膜色素上皮脱离的临床疗效。方法:回顾性分析自2005年以来,经间接眼底镜检查、彩色眼底照相、荧光素眼底血管造影(FFA)、吲哚青绿血管造影(ICGA)和光相干断层扫描(OCT)等检查确诊为黄斑部特发性浆液性视网膜色素上皮脱离21例22只眼,男性10例,女性11例;年龄47~75岁。主诉均有视力下降、视物发     

孤立性脉络膜血管瘤共焦激光扫描眼底血管造影影像分析

目的探讨孤立性脉络膜血管瘤共焦激光扫描眼底血管造影的影像学特征及其临床意义。方法采用海德堡HRA2共焦激光扫描血管造影系统对21例21只眼孤立性脉络膜血管瘤进行眼底血管造影检查，其中12例行荧光素眼底血管造影（fundus fluorescein angiography，FFA）检查，9例行FFA和吲哚菁绿血管造影（indocyanine green angiography，ICGA）同步检查，分析比较孤立性脉络膜血管瘤2种检查的影像学特征。结果FFA检查动脉前期或动脉早期血管丛状或斑状强荧光，静脉期强荧光灶明显渗漏融合，晚期瘤体呈弥漫性强荧光。6例瘤体表面有明显的不规则点片状弱荧光，13例瘤体表面及周围视网膜毛细血管扩张。10例可见与视网膜色素上皮带状萎缩相应的透见荧光。ICGA检查影像特征为早期瘤体由不规则网状血管团样强荧光，中期瘤体呈强荧光团，晚期所有病例均有特征性的“冲洗现象”。FFA和ICGA同步检查同屏显示，成像清晰，有可比性，ICGA比FFA更清晰显示瘤体范围。结论孤立性脉络膜血管瘤ICGA影像比FFA更具有特征性，并能清晰显示肿瘤大小边界；FFA则可清晰显示视网膜血管及视网膜色素上皮的继发性损伤。激光扫描FFA和ICGA同步检查可为孤立性脉络膜血管瘤诊断、治疗及疗效监测提供更多的临床信息。     

The role of optical coherence tomography angiography in reticular pseudodrusen

BackgroundTo investigate the changes in retinal and choriocapillaris vessel density (VD) in patients effected by early age-related macular degeneration (AMD) and reticular pseudodrusen (RPD), using Optical Coherence Tomography Angiography (OCTA).MethodsA total of seventy-eight eyes of 78 patients (43 male, 35 female, mean age 72.61 ± 5.15) with non-neovascular AMD (38 eyes with early AMD and 40 eyes with RPD) was recruited in this observational prospective study. Forty eyes of 40 healthy subjects represented the control group. The VD was measured in superficial capillary plexus (SCP), deep capillary plexus (DCP) and choriocapillaris in different macular regions.ResultsThere were no significant differences in VD of the SCP and DCP among the controls and the two study groups (p > 0.05). The VD of the choriocapillaris revealed a statistically significant reduction in early AMD and RPD groups respect to controls (p < 0.001). Furthermore, the patients with RPD showed a significantly decreased VD respect to patients with early AMD in different macular regions (p < 0.001).ConclusionsThe quantitative analysis of retinal and choriocapillaris blood flow by OCTA provided useful information regarding the vascular changes in non-neovascular AMD patients suggesting that the choriocapillaris loss is mainly involved in the pathogenesis of RPD.     

Prognostic factors associated with the course of vitreomacular traction in eyes with age-related macular degeneration

Clinical relevanceVitreomacular traction(VMT) is a clinical syndrome that can cause decreased vision and may affect the treatment response in cases of age-related macular degeneration(AMD). Factors affecting the course of VMT in AMD cases will guide the clinician in terms of patient management.BackgroundThe aim of this study was to determine the prevalence of VMT in patients with AMD, to evaluate the natural course of VMT, and to investigate factors associated with the prognosis of VMT in eyes with AMD.MethodsThis retrospective case series was conducted with 55 eyes of 46 patients who were diagnosed as having AMD accompanying with VMT. Demographic data, complete ophthalmologic examination findings, type of AMD, receiving an intravitreal injection(IVI), number of IVIs, and the presence of complete spontaneous release were obtained from the medical records of the patients. The horizontal length of VMT(HLVMT), central macular thickness(CMT), the horizontal length of choroidal neovascularization(HLCNV) were evaluated from spectral-domain optical coherence tomography(SD-OCT) images.ResultsSpontaneous release was observed in 7(28%) eyes of the exudative AMD group and 10(33.3%) eyes of the nonexudative AMD group. On the last visit, the HLVMT was increased in 22(40%) of the eyes and a decrease in HLVMT was observed in 8(14.5%) of the eyes. In the remaining 12(21.8%) eyes had unchanged HLVMT. In all eyes with CNV, the area of VMT corresponded in 100% with localization of the CNV complex. No significant difference was found between the eyes with spontaneous release and persistent traction in terms of the type of AMD, IVI, HLVMT, age, gender, and crystalline lens status.ConclusionIn this study, VMT was observed at higher rates in eyes with exudative AMD compared to the eyes with nonexudative AMD. However, spontaneous release rates were found close to those with idiopathic VMT independently of the type of AMD, HLVMT, and IVI.     

Detection of pachychoroid neovasculopathy with optical coherence tomography angiography versus dye angiography imaging

BackgroundTo investigate the sensitivity and specificity of optical coherence tomography angiography (OCTA) versus dye angiography for detecting pachychoroid neovasculopathy (PNV) and to determine the morphological factors that affect PNV detection.MethodsPatients with pachychoroid phenotype were prospectively enrolled and underwent multimodal imaging examinations during the same visit. The diagnostic accuracy of fundus fluorescein angiography (FFA), FFA combined with indocyanine green angiography (ICGA) and OCTA for PNV was evaluated using multimodal imaging as the reference. Multimodal parameters of PNV were qualitatively and quantitatively assessed.ResultsPNV was detected in 58 eyes (46 patients) out of 340 pachychoroid eyes (201 patients) according to reference standard. Patients with PNV eyes were significantly older (54.6±7.56 vs. 48.2±9.1 years), were more likely to have a chronic central serous chorioretinopathy history (CSC) (93.1% vs. 12.4%) and had a worse visual acuity (0.30±0.22 vs. 0.58±0.30) than those without PNV eyes (all P<0.001). The sensitivity of FFA, FFA combined with ICGA, and OCTA in detecting PNV in patients with the pachychoroid phenotype was 67.2%, 63.8% and 98.3%, respectively, and the specificity was 87.2%, 96.8% and 100.0%, respectively. PNV not identified by dye angiography was more manifested as the absence of late plaque hypercyanescence on ICGA (P<0.001) and overall smaller capillaries without a distinct pattern (P=0.001), fewer core vessels (P=0.002) and smaller area (P=0.044).ConclusionsOCTA showed superior detection rate and accuracy for identifying PNV over dye angiography. In case multimodal imaging is unavailable, OCTA can be an effective and noninvasive method for monitoring PNV and guiding treatment decisions.     

光动力疗法与光动力疗法联合玻璃体腔注射贝伐珠单抗治疗中心性渗出性脉络膜视网膜病变的比较研究

目的比较光动力疗法(photodynamic therapy,PDT)与PDT联合玻璃体腔注射贝伐珠单抗(bevacizumab)治疗中心性渗出性脉络膜视网膜病变(CEC)的临床疗效及安全性分析。方法 CEC患者46例46只眼,随机分为两组,对照组22例22只眼,联合组24例24只眼。对照组单纯PDT治疗,联合组行PDT治疗1周后行玻璃体腔内注射贝伐珠单抗1.5 mg(0.06 ml)。两组患者术后1、3、6和12个月随访复查最佳矫正视力、眼底、眼底荧光造影(FFA)、吲哚青绿荧光造影(ICGA)和光学相干断层扫描(OCT)。随访时若发现脉络膜新生血管(CNV)部分闭合或仍有渗漏,联合组再行玻璃体腔注射贝伐珠单抗治疗,最短间隔1个月;对照组再行PDT治疗,最短间隔3个月。比较两组患者治疗前后最佳矫正视力、眼底改变、FFA、ICGA、OCT等,评价其疗效及安全性。结果两组患者视力较治疗前均显著提高。两组患者眼底病灶缩小、出血吸收、视网膜水肿消退。联合组19只眼(79.2%)CNV完全闭合,5只眼(20.8%)CNV大部分闭合,轻微荧光素渗漏;对照组15只眼(68.2%)CNV完全闭合,7只眼(31.8%)CNV大部分闭合,轻微荧光素渗漏。OCT显示两组患者术眼视网膜下液吸收,CNV强反射区域明显缩小;联合组和对照组患者黄斑区视网膜厚度均显著缩小。联合组患者仅接受一次PDT治疗,贝伐珠单抗玻璃体腔注射平均治疗次数1.75次;对照组患者PDT平均治疗次数为1.86次。两组患者治疗过程中及术后随访均未见明显眼部或全身不良反应。结论 PDT或PDT联合玻璃体内注射贝伐珠单抗治疗CEC均安全有效,联合治疗能更有效封闭CNV,促进视网膜渗出及出血的吸收,同时减少PDT治疗次数,减轻患者的经济负担,降低并发症发生。     

光动力学疗法治疗脉络膜新生血管的临床疗效

目的 观察光动力学疗法(photodynamic therapy,PDT)治疗脉络膜新生血管(choroidal neovascularization,CNV)的近期临床疗效.方法 对70例(88只眼)CNV患者行PDT治疗.以治疗前、后第1周,1、3、6和12个月的视力,荧光素眼底血管造影、吲哚菁绿血管造影及光学相干断层成像术的检查结果作为临床观察指标,评价PDT治疗CNV的疗效.结果 治疗后第1个月复诊,78只眼视力提高,占88.6%;8只眼视力稳定,占9.1%;2只眼视力下降,占2.3%.治疗后第3个月,73只眼视力提高,占83.0%;12只眼视力稳定,占13.6%;3只眼视力下降,占3.4%.治疗后第6个月,73只眼视力提高,占83.0%;10只眼视力稳定,占11.4%;5只眼视力下降,占5.7%.治疗后第12个月,72只眼视力提高,占81.8%;10只眼视力稳定,占11.4%;6只眼视力下降,占6.8%.结论 PDT可单次或重复治疗黄斑部CNV,封闭新生血管后可使渗漏消退或减轻,是改善或稳定患者视功能的安全、有效方法.     

频域光学相干断层成像在黄斑疾病中的应用

目的：观察黄斑疾病在频域光学相干断层成像（OCT）扫描的图像特征。方法：用频域OCT检测黄斑部病变眼638例。结果：中心性浆液性脉络膜视网膜病变151例可见神经上皮脱离和（或）色素上皮脱离。黄斑裂孔46例黄斑中心凹神经上皮全层或部分缺失。干性AMD30例为RPE局灶性高反射信号,湿性AMD9例神经上皮或色素上皮下呈不规则的高反射层。黄斑水肿315例可见视网膜增厚及囊腔形成。视网膜前膜39例视网膜前呈高反射光带。中心性渗出性脉络膜视网膜病变31例为RPE下或RPE上的团块状高反射信号。视网膜劈裂10例视网膜反射信号减低,外丛状层拉长呈＂桥样＂连接。玻璃体黄斑牵拉综合症7例可见玻璃体后界膜中高反射条带与黄斑区相连。结论：频域OCT能发现以往OCT不能发现的微小病变,对黄斑部疾病诊断具有独特的临床应用价值。     

Comparison of microvascular parameters and diagnostic ability of optical coherence tomography angiography between eyes with primary angle closure glaucoma and primary open angle glaucoma

BackgroundTo investigate and compare the peripapillary and macular microvascular parameters between eyes with primary angle closure glaucoma (PACG) and primary open-angle glaucoma (POAG) using optical coherence tomography angiography (OCTA).MethodsSeventy-nine eyes of 43 patients with primary angle closure glaucoma (PACG), 78 eyes of 43 patients with primary open-angle glaucoma (POAG), 64 eyes of 35 patients with primary angle closure (PAC), and 73 eyes of 40 control subjects underwent imaging with OCTA. Perfusion density (PD) and vessel density (VD) for the macular area, and PD and flux index (FI) for the peripapillary area were calculated automatically. The area under receiver operator characteristic curves (AUC) were constructed to distinguish PACG and POAG eyes from healthy control eyes.ResultsThe peripapillary FI in all quadrants and PD and VD of the macular outer circle in superior and inferior quadrants were significantly lower in PACG and POAG eyes than in control eyes. The peripapillary FI in the inferior quadrant was significantly lower in the POAG group than in the PACG group (0.348 ± 0.06 vs. 0.369 ± 0.06, p = 0.04). The remaining OCTA parameters in the peripapillary and macular area did not show a significant difference between the POAG and PACG groups. Eyes with PAC presented significantly lower PD and VD than healthy control eyes at the superior and inferior quadrant of the macular outer circle, while retinal nerve fiber layer and ganglion cell inner complex thickness were not significantly different from than control eyes. The best diagnostic parameter was peripapillary FI in both PACG (AUC: 0.922) and POAG (AUC: 0.938) eyes.ConclusionsWe found significantly lower peripapillary FI in the inferior quadrant in POAG eyes compared to the PACG eyes, which may indicate the different underlying pathogenesis between POAG and PACG. The PAC eyes had lower macular PD and VD than normal eyes. This suggests that retinal vascular impairment may develop earlier than structural damage in PAC eyes.     

Choriocapillary regional characteristics in idiopathic macular holes using optical coherence tomography angiography

Purpose: To evaluate the characteristics of vascular density (VD) of the retinal capillary plexuses in idiopathic macular hole (IMH), the fellow eye, and healthy control eyes by optical coherence tomography angiography (OCTA).Methods: A retrospective cases series study involving 20 unilateral eyes (20 patients) with IMH, the unaffected fellow eyes (n = 20) and 20 health controls, with age- and sex-matched, was conducted in Shanxi Eye Hospital from January 2019 to December 2021. VD of the retinal capillary plexuses measurements were obtained by OCTA.Results: Four quadrants of superficial capillary plexuses (SCP) in IMH eyes were not significant compared with that in the unaffected fellow eyes (all P > 0.05). The four quadrants of deep capillary plexuses (DCP) in IMH eyes were lower than that in the unaffected fellow eyes (all P < 0.05). Different regions retinal thickness in the IMH eyes was higher than that in the unaffected fellow eyes (all P < 0.05). a significant negative correlation between deep vessel density and retinal thickness in different quadrants among IMH eyes (all P < 0.05). Additionally, the correlation between the vascular density of SCP and retinal thickness was significant in macular fovea area (= 0.519, P = 0.019). <0.001.Conclusions: The morphology of retina and choroid in idiopathic macular hole is different from that in fellow eye. The thickness of choroid in the fovea area of the unaffected eye also showed a decreasing trend. Taken together, the mechanism of macular hole may be further understood, that is, the decrease of choroid thickness may occur before the macular hole formation. It was verified again that the choroidal blood flow area in macular fovea of IMH patients was significantly lower than that in fellow eyes and healthy eyes.     

激光与曲安奈德治疗糖尿病性黄斑水肿的疗效比较

目的 对比激光与曲安奈德治疗黄斑水肿的疗效和安全性.方法 回顾性地分析46例50只眼具有完整资料的糖尿病黄斑水肿患者.其中23只眼行黄斑区局部或格栅样激光光凝(激光组);27只眼行玻璃体腔注射曲安奈德0.1 m1(4 mg)(曲安奈德组).随访24个月以上,观察视力、眼压、晶状体及眼底改变、荧光素眼底血管造影(WA)和OCT,比较两种疗法的疗效.结果 激光组与曲安奈德组术后黄斑水肿消退分别为20只眼(87.0%)和15只眼(55.6%);眼压升高10 mmHg以上分别为1只眼(4.3%)和9只眼(33.3%);术后行白内障手术分别为3只眼(13.O%)和13只眼(48.1%);差异均有显著意义(P<0.05).结论 激光比曲安奈德治疗糖尿病黄斑水肿更安全有效,不良反应更少.